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1. Maternal height linked to child mortality in India

JAMA 2009;301:1691-701

A national survey of Indian children has found a clear link between mortality in under 5s and maternal height.The absolute risk of death for children with mothers measuring at least 160 cm was 0.05 (95% CI 0.04 to 0.07) compared with 0.09 (0.07 to 0.12) for children born to mothers measuring less than 145 cm, a significant increase of 70% (relative risk 1.71, 1.37 to 2.14).

The authors also found a significant association between shorter stature in women and stunting, wasting, and underweight in their children. All three indicators of poor health were common. Nearly a half (17 428/40 089) of surviving children were stunted, 42.2% (14 791) were underweight, and nearly a fifth (7236) had wasting. The survey was nationally representative, and included between 40 000 and 50 000 children under 5 from all 29 states in India. The analysis was fully adjusted for demographic and social factors that influence childhood mortality.

The relative risks associated with each 1 cm decrease in maternal height were small but discernible, and the large numbers allowed the authors to calculate risks with some precision. They are fairly certain the link is real, and it shows how poor health in childhood, which determines growth, is passed from generation to generation.

2. Pharmacists reduce drug errors in outpatients with cardiovascular disease

Arch Intern Med 2009;169:757-63

Having a pharmacist on the team can help prevent drug errors and adverse drug events in hospital patients. Researchers found that the dedicated services of a pharmacist reduced the incidence of harmful or potentially harmful drug events by around a third (risk ratio 0.66; 95% CI 0.50 to 0.88). These events included mistakes in prescribing, mistakes in monitoring, preventable drug interactions, and near misses—mistakes that could have harmed someone but didn’t. Most adverse drug events in this analysis occurred in the 484 patients with complicated hypertension or heart failure.

The pharmacists gave advice and information; answered questions; kept track of patients and their treatment; and alerted doctors and nurses at the clinic to potential drug related problems. Which elements of the service reduced the incidence of adverse drug events is not yet clear.
BMJ 2009;338:b1826


3. Not so cool
BMJ 2009;338:b1951

Israel’s largest tobacco manufacturing company, Dubek, is being sued for adding menthol to cigarettes and for not warning smokers that the menthol prolongs the time that toxins remain in the lungs. The suit is on behalf of a 47 year old mother who died of lung cancer after smoking menthol cigarettes for many years.


4. Fewer mums are married
BMJ 2009;338:b2017

Almost 40% of births in the United States in 2007 were to unmarried women, according to the Centers for Disease Control and Prevention. The rate has more than doubled since 1980, when it was 18.4%. Women under the age of 20 accounted for 23% of births to unmarried mothers in 2007, down from 50% in 1970 (www.cdc.gov/nchs/data/databriefs/db18.pdf).


5. Drugs agency grants its first licence to homoeopathic product.
BMJ 2009;338:b2055

The United Kingdom’s drugs agency has given a licence to the makers of a homoeopathic product, despite scientists and researchers saying that no evidence shows that it works.

Professor Colquhoun commented, "The products are supposed to say ‘used in the tradition.’ But will the average consumer really understand this? They are weasel words that will be taken by the consumer that a product works," he added.


6. A tale of blind faith
BMJ 2009;338:b2069

Nigel Hawkes reviews a television documentary highlighting how patients are paying heavily for unproved stem cell therapy in the private sector

"Always too eager for the future, we / Pick up bad habits of expectancy," wrote Philip Larkin in a poem that explores people’s preference for the promises of tomorrow over today’s humdrum reality. Nowhere is this truer than in health care, where the belief that a miracle treatment is just around the corner has the public by the throat. Scientists competing for grants, and journalists for headlines, keep this belief alive through every disappointment.

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To these it can now add Mr and Mrs Clarke, who are convinced that their daughter’s sight has improved. "It’s amazing, it’s absolutely amazing," said Darren.

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"None of us has seen evidence of visual improvement—of any quantitative visual improvement of any kind," he said. Even temporary? "No, we have no evidence of the sight improving temporarily. But there is a very interesting dynamic, that old saying that children can feel their parents’ expectations in the next room."

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Along with tales of heroic breakthroughs, the undergrowth of medical literature has plenty of stories of doctors who were proved right despite the disbelief of their peers. Some are even true. So patients are not put off by the lack of clinical trials or the disdain of medical orthodoxy. They see mainstream opinion as jealous and conservative, reluctant to give credit to the pioneers who are pushing the frontiers—a judgment that has been correct just often enough to give it credibility.

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Dr Tychsen made the saddest remark of all. When he tests the vision of children treated by Bieke, their parents don’t even ask for the results. "They have invested a tremendous amount of time in this," he said. "They typically have recruited the entire community to help support them. The expectations are high, and I’m not sure that they want to know that you think they have wasted their time and money."

Dr Rader, confronted with the evidence that he had pressured Ms Oatley to have the treatment, lost his temper briefly but quickly saw the bright side. "In the long run it doesn’t hurt me as long as you spell my name correctly," he said, "because parents don’t give a damn about this intellectual shit . . . These parents will still come to me. We will get patients out of this." And, as good as Panorama’s investigation was, he may be right.

7. The ups and downs in the life of a foundation year doctor
Student BMJ 2009;17:b1873

As a junior doctor you experience good and bad days. The good days are fantastic. Successfully deducing the cause of my patient’s nausea and easing his discomfort is satisfying. Inserting the cannula that no one else has been able to or performing a lumbar puncture makes me feel skilled. And although I’m more likely to be performing a digital rectal examination than sit in a plush office, and although the free perks of the NHS are limited, the sense of camaraderie among junior doctors is a perk second to none.

Full text here.